Status of human cystic echinococcosis based on hospital records in Mazandaran Province: A first registry-based evidence

Background

Human cystic echinococcosis, as an emerging neglected parasitic disease, is caused by tapeworms of the genus Echinococcus spp. Because of the medical and economic importance, this study aims to review the epidemiology and clinical features of hydatidosis in patients admitted to medical and surgical wards in three referral teaching hospitals over 15 years in Mazandaran Province, northern Iran.

Methods

Data were collected from hospital records that were accessible via the hospital information system (HIS) between 2005 and 2019 (15 years).The demographic information (age, sex, living area, and occupation), dog contact, number of the cysts, types of organs involved, and history of disease recurrence were assessed.

Results

One hundred twenty-one patients with human cystic echinococcosis (CE) were involved in the study, from whom 58 patients (47.93%) were male and 63 (52.07%) were female. The majority of patients were rural residents (64.46%) and also housewife (28.10%). Based on the results, only about 16.53% of the patients had history of close contacts with dogs. The liver was the organ involved in the most cases of CE. There were statistically significant differences between residence, occupation, history of close contacts with dogs, type of organs involved, number of cysts and history of disease recurrence (P < 0.05).

Conclusions

Our data provides valuable registry-based information about CE in an endemic region. The data highlights that most patients lived in rural areas and were housewives. Additionally, they had a low rate of disease recurrence but a high rate of close contact with dogs. Moreover, further monitoring on registry-based program and strengthening the HIS in the provincial hospitals in the studied area are required.

Credible Serological Evidence of Latent Toxoplasma Infection Among Women with Primary Infertility: A Ten-Year Registry-Based Study

BACKGROUND

Some evidence reveled that chronic infection with Toxoplasma gondii (T. gondii) has recently been associated with infertility in human and experimental model. This baseline study aimed to investigate serological evidence of Toxoplasma infection among infertile women who admitted to the in vitro fertilization (IVF) clinic at Imam Khomeini Hospital, Mazandaran province, Sari, northern Iran.

SUBJECTS AND METHODS

In this retrospective (descriptive-analytical) study, all infertile women referred to the IVF clinic during 2010-2019 (10 years), constitute the study population. All data including demographic and some related characteristics were collected into a questionnaire and registered at the Iranian National Registry Center for Toxoplasmosis (INRCT) at the Mazandaran University of Medical Sciences, northern Iran. The existence of anti-Toxoplasma antibodies (IgG and IgM) was explored using a commercially available enzyme-linked immune sorbent assay (ELISA) kit (PishtazTeb, Iran), based on the manufacturer's protocol.

RESULTS

Of 520 infertile women, anti-T. gondii IgG, IgM and both IgG and IgM antibodies were detected among 342/520 (65.77%), 1/520 (0.19) and 4/520 (0.77) infertile women, respectively. Primary and secondary infertility was detected in 74.56% and 25.44% of IgG seropositive infertile women, respectively. Also, most of the IgG seropositive subjects had no history of abortion, polycystic ovary syndrome (PCO), fibroma, contraceptive use and varicocele in spouse as primary cause of infertility. Furthermore, serum levels of prolactin and antimullerian (AMH) hormones were normal in 81.29 and 80.12% of infertile women with anti- T. gondii IgG, respectively. There was also a statistically significant difference between the seroprevalence of Toxoplasma infection and these variables associated to primary infertility (P < 0.05).

CONCLUSION

According to the high prevalence (about two thirds) of chronic T. gondii infection among infertile women, particularly those with a history of abortion and primary infertility, it can be concluded that latent Toxoplasma infection pose a risk to infertile woman in the study area. Therefore, we advise that screening and treatment of Toxoplasma infection among infertile women must be favorably considered.

Two decades of echinococcosis/hydatidosis research: Bibliometric analysis based on the web of science core collection databases (2000-2019)

Echinococcus granulosus sensu lato and Echinococcus multilocularis are responsible for serious health and economic implications for humans and animals. This study was designed to conduct a bibliometric analysis of global research on echinococcosis/hydatidosis included in the Web of Science Core Collection databases from 2000 to 2019. A total of 7066 relevant articles between 2000 and 2019 were identified. Most articles were published in 2015 (502 articles), 2017 (492 articles) and 2018 (493 articles), with the Veterinary Parasitology journal publishing the largest number of articles (237). Researchers from Xinjiang Medical University, China authored the most articles (388) in the field. Authors Craig, P.S. and Deplazes, P. were the most active in publishing143 and 126 hydatid cyst research papers, respectively. The most echinococcosis/hydatidosis publications originated from Turkey, China and Iran, with 1210, 708 and 531 articles, respectively. The highest levels of research collaboration were evident between China- England, China-France, England-France, China-Australia, and China-Japan. Also, the top researchers in this field had relatively extensive collaborations with each other. Our bibliometric analysis provides a picture of the scientific research into the echinococcosis/hydatidosis field. Further multi-national collaborative research efforts in this field should show promising progress in the future.

Toxoplasma gondii infection in patients with rheumatoid arthritis and systemic lupus erythematous diseases: serological and molecular evidence

This study aimed to determine Toxoplasma gondii infection in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients in Mazandaran Province, north of Iran. During April 2019 to February 2020, 305 patients with RA (N=272) and SLE (N=33) diseases are included in this cross-sectional study. The baseline data of patients were collected into a questionnaire. Also, blood sample was taken from each patient in tubes containing k2-EDTA as anticoagulant for serological and molecular analyses. The presence of specific IgG antibody against T. gondii in plasma was explored using ELISA method. DNA was extracted and conventional-PCR method was done using RE primers on buffy coat samples. Anti-Toxoplasma IgG were detected among 105/272 RA (38.6%) and 11/33 (33%) SLE patients (P=0.55). IgG seropositivity was more common in females (95.70%) than in males (4.30%) and in 51-60 years old patients (37.10%) in rural populations (62.07%). Also, seropositivity was higher in patients who kept cats (93.95%). Keeping cats and patient's age were two studied risk factors which had significant relations with T. gondii seropositivity in patients (P<0.05). Overall, T. gondii DNA was found in 60 of 305 (19.7%) of enrolled patients, whether serology positive or negative (P<0.0001). Given the RA and SLE patients can be considered as a risk group for toxoplasmosis, in addition to the serological test, PCR based techniques is recommended for early and accurate detection of recent T. gondii infection.

Suicide attempt using zinc phosphide rodenticide: A case report and literature review

The patients with a history of intentional or unintentional consumption of rodenticide compounds, especially ZnP, it is necessary to assess ABG and abdominal radiography.

Acute pancreatitis due to methanol toxicity during the COVID-19 pandemic

Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37-year-old man with acute pancreatitis due to methanol poisoning during the COVID-19 pandemic.

Occurrence of hypoglycemia in patients with benzodiazepines poisoning: A cross-sectional study

Background

Benzodiazepine (BZD) poisoning is a common medical condition often accompanied by respiratory arrest, aspiration pneumonitis, and may rarely result in death. Although it is not studied well, hypoglycemia is a real and life-threatening condition that may occur in BZD poisoning. Thus, the present study was shown to determine the prevalence of hypoglycemia among patients with BZD poisoning compared to toxicity with other drugs.

Patients and methods

In this study, patients with drug-induced poisoning referred to Vasei hospital, Sabzevar, eastern Iran, were registered and their blood glucose levels at presentation were collected during 2019.

Results

Overall, 300 poisoned patients were evaluated (17% with BZD poisoning). The prevalence of hypoglycemia was significantly higher in patients with BZD poisoning (11.8% vs. 2.8%, p = 0.004), especially in males (P = 0.016), aged >30 years old (p = 0.006). However, the prevalence of hypoglycemia was higher in patients with GCS<10 (p = 0.005) and in patients referred later than 1 h to a medical center (p = 0.015).

Conclusion

Results were show that hypoglycemia is a frequent complication of BZD poisoning and should be considered in the initial evaluation of patients referred to the emergency department with this medical condition.

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The Occurrence of hypoglycemia in patients with Benzodiazepines poisoning.

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Benzodiazepine (BZD) poisoning is a common medical condition often accompanied by respiratory arrest, aspiration pneumonitis, and may rarely result in death.

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The hypoglycemia is a frequent complication of BZD poisoning and should be considered in the initial evaluation of patients referred to the emergency department.

Global status of neglected human Linguatula infection: a systematic review of published case reports

Human linguatulosis is a rare but highly specialized pentastomid parasitic infection all around the world. The disease is caused by worm-like parasites which share some morphologic features of arthropods and annelids. The life cycle of Linguatula spp. is provided as an example of pentastomid biology. The adult forms of Linguatula spp. are found in the nasal passages and frontal sinuses of dogs and other canids, domestic animals, and humans. Infestation may occur in the viscera, where immature forms develop in the liver, spleen, lungs, eyes, and other organs, or in the nasopharyngeal area. This review includes previous studies on the genus Linguatula in Iran and other countries from 1940 to 2019. Considering a few reports of human infestation, a comprehensive search was performed on both English and Persian databases for publications reporting human cases all around the world. Finally, 30 papers of 62 human cases were included in this study. The mean age of the patients was 25.8 years (varied from 8 to 79 years). Altogether, 41 (66.1%) and 21 (33.9%) of the patients were female and male respectively. The maximum cases (n = 25) were from Sudan. Nasopharynx was the most frequently involved organ in human cases. Our findings offer that physicians should consider the Linguatula infection in patients with complaints like unexpected dysphagia, with coughing, sneezing, and vomiting, after consuming raw/undercooked contaminated ruminant's viscera.

Mild-to-severe poisoning due to Conium maculatum as toxic herb: A case series

Conium maculatum toxicity may occur by mistakenly or intentionally eating this plant. Due to muscarinic or nicotinic symptoms associated with this plant toxicity, supportive care and treatment with atropine are urgently important.

Alkaline phosphatase and score of HRCT as indicators for predicting the severity of COVID-19

BACKGROUND

The clinical symptoms, blood laboratory data, O2 saturation and high-resolution computed tomography (HRCT) findings are critical factors in diagnosis of COVID-19 infection.

METHODS

In this study, 105 hospitalized patients suspected of having COVID-19 were evaluated. Finally, the laboratory and HRCT and related factors data of 83 confirmed cases by HRCT and RT-PCR were analyzed. To compare the median of quantitative variables in the two groups, the Mann-Whitney U test was used. Also, to determine the factors associated with the positiveness of the HRCT result, a univariate logistic model was fitted. Moreover, receiver operating characteristic (ROC) curves were constructed to test the ability of the final model to predict the positiveness of HRCT result.

RESULTS

61.40% of the patients had a comorbidity disease. 89.20% had fever, 92.00% cough, 91.40% dyspnea. Abnormal CRP was seen in 77.80% of the patients, followed by 66.70% lymphopenia, and 60.30% neutrophilia. Also, ALP (abnormal vs. normal) and score of HRCT assessment variables had a significant effect on the positiveness of HRCT findings. 87.95% had abnormal HRCT with 41% bilateral multi lobar patchy ground glass opacity (GGO). Moreover, there was a statistically significant association between the level of O2 saturation and HRCT results.

CONCLUSION

Our findings showed that male patients with middle age and comorbidity disease were more susceptible to the COVID-19 infection. Additionally, clinical features, blood laboratory findings, O2 saturation and HRCT findings are critical factors in the prognosis of COVID-19 infection.

A Bibliometric Analysis of Global Research on Lophomonas Spp. in Scopus (1933-2019)

BACKGROUND

This study was designed to analyze the global research on Lophomonas spp. using bibliometric techniques.

METHODS

A bibliometric research was carried out using the Scopus database. The analysis unit was the research articles conducted on Lophomonas spp.

RESULTS

A total of 56 articles on Lophomonas spp. were indexed in the Scopus throughout 1933-2019 (87 years) with the following information: (A) The first article was published in 1933; (B) 21 different countries contributed in studies related to Lophomonas spp.; (C) China ranked first with 16 publications about Lophomonas spp.; and (D) "Brugerolle, G" and "Beams, H.W." from France and the US participated in 4 articles respectively, as the highest number of publications in the Lophomonas spp. network.

DISCUSSION

After 87 years, Lophomonas still remains unknown for many researchers and physicians around the world. Further studies with high quality and international collaboration are urgently needed to determine different epidemiological aspects and the real burden of the mysterious parasite worldwide.

Massive cutaneous complications due to snakebite: A case report and literature review

Wound infections due to snake bites such as cellulitis and necrotizing fasciitis, although not common, are seen in snake bites and if left untreated can cause serious complications.

Fulminant hepatorenal syndrome due to Acetaminophen toxicity: A case report

HRS is a rare and poor prognosis complication of chronic acetaminophen toxicity, which presents by progressive decline in renal function secondary to liver failure.

Co-morbidity of Covid-19 and Stenotrophomonas maltophilia in a patient with Hodgkin's lymphoma history from north of Iran

Immunocompromised patients, especially those hospitalized, are at higher risk for infection with opportunistic pathogens such as Stenotrophomonas maltophilia (S. maltophilia) which is a multidrug-resistant gram-negative bacillus and can cause a challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. A 71-year-old man with Hodgkin's lymphoma presented with severe respiratory symptoms of COVID-19 and was intubated upon admission and the initial standard treatment for COVID-19 was started for him. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia. According to that, the patient's intubation tube was removed and a tracheostomy was performed for him. Also, antibiotic treatment was replaced with Colistin and Co-trimoxazole drugs. Finally, after 31 days of hospitalization in the ICU and the aappropriate drug treatment, he was discharged with reduced symptoms and partial recovery. It should be noted that the occurrence of co-infection with multidrug-resistant pathogens such as S. maltophilia requires proper management to select appropriate treatment methods and drugs so that in addition to proper effectiveness, it does not lead to side effects and complications associated with COVID-19 disease.

Comparative evaluation of amniotic fluid as an alternative to fetal bovine serum in the maintenance of Leishmania major and Toxoplasma gondii

This study aimed to evaluate the efficacy of amniotic fluid (AF) as an alternative to fetal bovine serum (FBS) in the maintenance of Leishmania major promastigotes and Toxoplasma gondii tachyzoites. AF was collected by an obstetrician using sterile syringes during a cesarean section. The culture medium was supplemented with 5 different concentrations of FBS or AF including 2, 5, 10, 20, and 30%. These concentrations were used to maintain both mentioned parasites. L. major was maintained at temperatures 4 and 24 °C and examined once a week for 4 weeks, while T. gondii was maintained at temperatures 4, 24, and 37 °C and examined at hours 24, 48, 72, and 96. For L. major, at both 4 and 24 °C, we observed no significant difference between FBS and AF on day 7. However, on days 14, 21, and 28, the difference between FBS and AF was significant at both temperatures. For T. gondii, no significant difference was observed between FBS and AF at hour 24 and all temperatures. However, this difference was significant at hours 48, 72, and 96 and all temperatures. According to our results, although FBS had a greater efficacy than AF in the growth of L. major and the survival of T. gondii, the number of promastigotes increased over time in AF-containing medium and the number of tachyzoites reduced slowly with a mild slop. Therefore, AF can be a potential alternative to FBS.

First Autochthonous case of Emerged Zoonotic Cutaneous Leishmaniasis in Mazandaran Province, Northern Iran: kDNA-PCR Evidence Base

BACKGROUND

In the last decade, several cases of cutaneous leishmaniasis (CL) have been recorded by the provincial health center of Mazandaran Province, northern Iran. However, there is no documented report of autochthonous CL in the province yet.

CASE PRESENTATION

The patient, a 59-year-old female, known case of diabetes mellitus, lived in therural area of Kiasar district (in theeastern part of the Mazandaran) with 5 skin lesions suspected of having vasculitis, without ahistory of traveling to the endemic areas of CL,was admitted to Imam Khomeini teaching hospital, Sari. To rule out CL, fine needle aspiration(FNA)procedure was used aseptically for the patient. Laboratory investigations showed Leishman bodies (amastigotes) by direct smear preparation, and species identification confirmed Leishmania major (L. major) by polymerase chain reaction (PCR)molecular method. Accordingly, this is the first documented report of autochthonous CL in Mazandaran Province.

CONCLUSION

Overall, due to the abundance of probable rodent reservoir hosts and confirmation of infectionof sandflies (Phlebotomus papatasi) withL. major in the Kiasar district, where our patient was livingthere, it seems that CL emerged in the eastern part of the province. Therefore, further studies on rodents and sandflies fauna in terms of emerging leishmanial infection in the area is recommended.

Status of Linguatula serrata infection in livestock: A systematic review with meta-analysis in Iran

Objectives

The present systematic review attempted to determine the prevalence of Linguatula serrata (L. serrata) infection among Iranian livestock. The L. serrata known as tongue worm belongs to the phylum pentastomida and lives in upper respiratory system and nasal airways of carnivores. Herbivores and other ruminants are intermediate hosts.

Methods

MEDLINE, Embase, Web of Science, Google Scholar, and the Cochrane Library were searched from Nov 1996 to 22 Apr 2019 by searching terms including "Linguatula serrata", "linguatulosis", "pentastomida", "bovine", "cattle", "cow", "buffalo", "sheep", "ovine", "goat", "camel", "Iran", and "prevalence" alone or in combination. The search was conducted in Persian databases of Magiran, Iran doc, Barakatkns (Iran medex) and Scientific Information Database (SID) with the same keywords. After reviewing the full texts of 133 published studies, 50 studies had the eligibility criteria to enter our review.

Results

By random effects model analysis, the pooled prevalence of linguatulosis was 25% (95%CI: 18.0-33.0, I ² = 98.67 % , P < 0.001) in goats; 15.0% (95%CI: 10.0-20.0, I ² = 97.95 % , P < 0.001) in sheep; 12.0% (95%CI: 7.0-18.0, I ² = 98.05 % , P < 0.001) in cattle; 7% (95%CI: 2.0-16.0, I ² = 97.52%) in buffalos and 11.0% (95%CI: 6.0-16.0%, I ² = 96.26 % , P < 0.001) in camels. The overall prevalence in livestock was estimated to be 25%. The highest infection rate was recorded in West Azerbaijan Province (68%) and the lowest rate was in Khuzestan Province (0.23%) (P < 0.05).

Conclusions

We concluded that the high prevalence of L. serrata infection in livestock (mainly ovine linguatulosis) show the endemic status of linguatulosis in several parts of Iran and will pose a risk for inhabitants. Control strategies to reduce the parasite burden among these animals are needed.

Electrophoretic pattern of Linguatula serrata larva isolated goat mesenteric lymph node

Linguatula serrata, one of the parasitic zoonoses, inhabits the canid and felid respiratory system. The parasite is tongue-shaped, lightly convex dorsally and flattened ventrally. Males measure 1.8-2 cm, while females measure 8-13 cm in length. Disease due to infection with this parasite in humans is more likely to cause pharyngitis, nausea and vomiting, sore and itchy throat, cough, phlegm and runny nose. Present study aimed to determine linguatula's larva somatic antigens in lymph nodes of infected goats and also reveal the major component of antigenic protein. To determine the electrophoretic pattern of L. serrata's larvae, 50 samples were taken from goat's referred to the slaughter house of Amol, Mazandaran, Iran. After performing SDS-PAGE on somatic antigens, 6 bands (19, 20, 36, 48, 75,100 KDa) were seen in which the 36, 48 and 75 KDa bands were more prominent. In conclusion, it is recommended to determine the most important antigenic protein of this parasite could be used an experimental model in infection up to determine the most significant component of this parasite's antigen and use of that in immunogenicity and detection of infection.